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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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COVID-19 associated diarrhea differential diagnosis

Introduction

For COVID-19 frequently asked outpatient questions, click here
For COVID-19 frequently asked inpatient questions, click here

Overview

Overview

COVID-19 diarrhea must be differentiated from diarrhea due to other organisms such as secondary bacterial infections, Clostridium difficile associated diarrhea, Viral causes and parasitic causes. [1]

Differential Diagnosis

Differential Diagnosis

Organism Age predilection Travel History Incubation Size (cell) Incubation Time History and Symptoms Diarrhea type∞ Food source Specific consideration
Fever N/V Cramping Abd Pain Small Bowel Large Bowel Inflammatory Non-inflammatory
Viral Rotavirus <2 y – <102 <48 h + + – + + – Mostly in day cares, most common in winter.
Norovirus Any age – 10 -103 24-48 h + + + + + – Most common cause of gastroenteritis, abdominal tenderness,
Adenovirus <2 y – 105 -106 8-10 d + + + + + – No seasonality
Astrovirus <5 y – 72-96 h + + + + + Seafood Mostly during winter
Bacterial Escherichia coli ETEC Any age + 108 -1010 24 h – + + + + – Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
EPEC <1 y – 10† 6-12 h – + + + + Raw beef and chicken –
EIEC Any ages – 10† 24 h + + + + + Hamburger meat and unpasteurized milk Similar to shigellosis, can cause bloody diarrhea
EHEC Any ages – 10 3-4 d – + + + + Undercooked or raw hamburger (ground beef) Known as E. coli O157:H7, can cause HUS/TTP.
EAEC Any ages + 1010 8-18 h – – + + + – May cause prolonged or persistent diarrhea in children
Salmonella sp. Any ages + 1 6 to 72 h + + + + + Meats, poultry, eggs, milk and dairy products, fish, shrimp, spices, yeast, coconut, sauces, freshly prepared salad. Can cause salmonellosis or typhoid fever.
Shigella sp. Any ages – 10 – 200 8-48 h + + + + + Raw foods, for example, lettuce, salads (potato, tuna, shrimp, macaroni, and chicken) Some strains produce enterotoxin and Shiga toxin similar to those produced by E. coli O157:H7
Campylobacter sp. <5 y, 15-29 y Р104 2-5 d + + + + + Undercooked poultry products, unpasteurized milk and cheeses made from unpasteurized milk, vegetables, seafood and contaminated water. May cause bacteremia, Guillain-Barr̩ syndrome (GBS), hemolytic uremic syndrome (HUS) and recurrent colitis
Yersinia enterocolitica <10 y – 104 -106 1-11 d + + + + + Meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk. May cause reactive arthritis; glomerulonephritis; endocarditis; erythema nodosum.

can mimic appendicitis and mesenteric lymphadenitis.

Clostridium perfringens Any ages > 106 16 h – – + + + Meats (especially beef and poultry), meat-containing products (e.g., gravies and stews), and Mexican foods. Can survive high heat,
Vibrio cholerae Any ages – 106-1010 24-48 h – + + + + Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish. Hypotension, tachycardia, decreased skin turgor. Rice-water stools
Parasites Protozoa Giardia lamblia 2-5 y + 1 cyst 1-2 we – – + + + Contaminated water May cause malabsorption syndrome and severe weight loss
Entamoeba histolytica 4-11 y + <10 cysts 2-4 we – + + + + Contaminated water and raw foods May cause intestinal amebiasis and amebic liver abscess
Cryptosporidium parvum Any ages – 10-100 oocysts 7-10 d + + + + + Juices and milk May cause copious diarrhea and dehydration in patients with AIDS especially with 180 > CD4
Cyclospora cayetanensis Any ages + 10-100 oocysts 7-10 d – + + + + Fresh produce, such as raspberries, basil, and several varieties of lettuce. More common in rainy areas
Helminths Trichinella spp Any ages – Two viable larvae (male and female) 1-4 we – + + + + Undercooked meats More common in hunters or people who eat traditionally uncooked meats
Taenia spp Any ages – 1 larva or egg 2-4 m – + + + + Undercooked beef and pork Neurocysticercosis: Cysts located in the brain may be asymptomatic or seizures, increased intracranial pressure, headache.
Diphyllobothrium latum Any ages – 1 larva 15 d – – – + + Raw or undercooked fish. May cause vitamin B12 deficiency

∞Small bowel diarrhea: watery, voluminous with less than 5 WBC/high power field

Large bowel diarrhea: Mucousy and/or bloody with less volume and more than 10 WBC/high power field

† It could be as high as 1000 based on patient’s immunity system.

References

References

  1. ↑ Occhipinti V, Pastorelli L (2020). “Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a “Red Zone” Area in Northern Italy”. Inflamm Bowel Dis. 26 (6): 793–796. doi:10.1093/ibd/izaa084. PMC 7188155 Check |pmc= value (help). PMID 32314792 Check |pmid= value (help).

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2] Ifrah Fatima, M.B.B.S[3]